Cholestasis. Cholelithiacis Cholecystitic Colestasis Colestasis Ly poneranan thin empeds barene gan skrei deh epaosit gia dates lit empess melald Seluran fempedu inten abu chtrahepatt- © Bedaan oy jaundice — Pracanyn bia tad pre heya ~F gyn Sel dara mermh (arena © Relertasis — VelTh — Fepada proter_pembenttwnntya aleln TT tet den Sunt ak cove ching Meade doge ble terbentik 4g baile ty berrunbsal chundice obstnistir / surgical pundice gy Terchan sl onped ode 3 mecoen 1, cibmdbetaL Alvar caluran 2: pasien dy co Glorectl tapi ade penyeharan Melalui Hep selinga Hes ai perihepatic. atom rembesar dan menetan + obra 2. Mayaiah Ai dindiég, Salucan ©: povien dy, Clarglocatsiroma — Yo Morjngtons: dori ding Saluran erred 3. Macalah dalam mules babe sumbatzn ares «hard ating Hs de tty — pry edi pruritus thy pada fasten janice Jed ler tbs enifetess Wisma dow eurlien 4 Pada pasion ander Dengan Fodar Viiein talent (oneal >20 Wg /A) + akan Heypds pie acid trcty *, Tardanga proc» Wp in We Hoe ecenoneg gen “abu Koma hepatibum + Tanda ile acxt tpkicly + ditudai dy ful yy werghtem 7 ferene depot’ ble a abuts + Inplame chon berlarjat ow dey mengharien cibkin Fro imflamasi —+ Abate teed? peringhaton Firois , dncbperia — filbrais biter dan fibeasis di eke Vera ports + dibiarhan dolam , pega Parjang ata wenyohabtan “Malignancy” Wanspormaton® Feganasan eral AF inplameri Honis rete ay ee nee oe ee ate eee os © Deer Hern te Hadar Win tehengegs > 2 Wy A = Jad bay Waindin <2. —* Fesora Kins fam eat - Laren a deny eda ica ruta © Win delay enema Vinkin yy terhentih todaBak iid dice” maupun rairecs! Mornin masala ada poryunipstn d etraupat 4 thcara odo, Viindin yy lant dolar air Lbitinabin 2) Uy akon Femboli be dalam liver dan measuk fe abian dave, + diterutan di win + usin gelap: © Cttaneeus jaundice > bitinibin 25 mg/dl © Gvare pruritus — Vitinbin meningkats ox lipet Clering di - afAS bo Wg /AL Vemetitsoan Fate + Haus /Jounstce + Keratdning / gata + Xanthones — Panumputen Lipid yp beskelompot di bale Getitor palpebrn) © Failure bs thrive —+ paren pediatste Laberatoriven © iin tat. itech. direct © + sor! sort © Hor menandatan tumbatan : # gamnnn — glutamyl baryverye (gamma Gt) don altaine prspatoic. =f iL Folererol & Upprtein = HL = wermal atu rendabe = empires log + tumor marker C54 + of mirat metntasis. , CA tag + tor cal. Wier teMtan parks Treatment: © Pembedahan berdaac et Gewra Prisip + mulqi dt tindekan yg non need, wine. mug don iwvasi F 1 Nom invasiP = ERCP ( Eedosccgic. ebagade Colangio jarcieaogoyy| 4 EE A eee + Shngeraay aS cams Cast bay * ferauaggan Ant bier a vines inva Laaraopy) 4 Waste: open a eat a Insc opr on eases a aaj Sermngen sae) pa emColelithiasis ars taitgy ented rtnage Yq dlimpan terone L saat berpasa at di Soluran empeds secarn umum (sal- biter inter hepatic. tanking erupts, common hepate dict , cha) 4 bebe di bantu enpedu / gallblader — foleritoitasis . * bate di Chd — koledoolitias, + babe intra hupstic: + intra hepatic: stone. + biked Ch — Common hep: dct ome Kantorg Empedu /faifelader — lokast di Foadran fenan ates — tapat di areas ortacum ya 9 ~ memberor = tebe sect palpar’ = Salam emped lng. ital: J hag te arden oops we (oa ce) liken bemdna din on M4 pte ae a et? dea orig (yh 5 2 sna i 305 wrong — Hy in ne a) + Sask mataran_beriemat — empedu atan felvar , toutrma 1 tersargan enaimn eestvtain yy diprodee! di dusdenur l Pada Sant prasa » ditiNiah ponyimpanon mya. Soot puns , ffingtes o@di atan Kontsahii — tenedi atic empes deci begat maw gillleder Liveage) ‘ Tati yoda tas atu empedy /boleritiby gallblader ys th belch divang —* fiat apa Larne Rargiiaye fragt Storage, 1 Wy Falau Abvory 4 beberatn tube di-katntan , sal: eompede Soper con aton bord! [ee sebagai ompense Aiihat tentang enpeds yy [tidak ada lagi preg € 10 meme (0,3 ~ 04 0m) Melhor Ji 0.0 6.7 mm) Poses ni tathattan berjs ensiin dam neurohumoral excitation — tamargan al: terme tty dor Yerrarazan Yogut Jd Yong relibathan talabiar’ maupun fonbrati dari rrinter dari sol: bitier - Komponen dai bilier lempedss- CEO'S. commentembentikon Gallstone / Babe Bmped. + Secapa. gos Wear terbagi 3: 1. Babs belesterol 2. Bate figen — “Pigmen cakium WAinybinee” 2. Bah tix — womomnyes babe aps Tend hipessaturai dor, Feleterol- “Wigs erena eH mh mening ] (aspen foleter. Fe dato Ui verse) Ada ogi “tall bangle” Liternprnen ened » mepltn ten ate feleteob- Suda tert dest flee. fly, be alt 4 Pa teat gangquan stan wnreabhon lierateesi 1 frei. Jon — porteriten bt. © Terharte re wate Wie gig bar foktor lain = Wipersetees Iasi, Mobltas Kantony ped Wy brkarary Karn Yrs Tadong + empelu suit beer —+ Font phat + Desi intetinel sendiri —+ tapdi peingatan Fonverr dau Petuishan te aman _deorychaate Jodi empedy wi aten wasut dari drodenum dan becabhir di Tebitwe ileum terwinat, (dma) don sabi. —+ diane shan tured Pemyerapan lerbeli + kanjed? Proves Perubehon Lagi Clonjugast) — kerkanbk deoxycholate yg werupaton Primary De ble st Hipersebresi olesteroL * Apokah ade teitanya toleterd darah dan batu foleteral?7 Ly tio ode taitanyn, tarena folateol doa 4 Sys! vb berada di lwor hepa. Den Ai tiver ni sfolaterd thy masuk te liver erene Sdvenarryo ado Newptot v Contsh Aptipeprotein B/e receptors ug warupokan repr Ai pexmutaan Uver. —> pade beberapa onary reper Wi bonyat ebinggn Weiter yy ade di dolor decal ye atom Mark Fe dalam ier. Aienting Yo dseray Meldui uses Cherbextve serum poprotein 7 dine, jadi Folesterot. erter) TCahuadsteyas Free Peete ini, prseinya verwacom’ , dan frre cletet Jint aan tm tenutan a dalam Caivan empeds Sel saturye Aiba abbr lurnonat efeaen dimara ia mevinghaton Manny forum Uipatein Woringtatton fembenben free Glester Jat Ue didn manjedi chelebersh aster —+ ade 2 enim uma gy berperen (chleterd eter iyarolnge don act) T recut menjnd’ folate efter Fomlal namun pores Ini dihambet 4! progertorm 4 Bai prrogen + meringtatton pembentuton foletrt agate + renghambat- Obeitar — stam weninghattan fombentuton free Folekeet Avnana lesterol ivi sumbereye dari Kab J Jodi disomping leben ester yy bseray dari maheran, Aru rman fe lives cali MeIOT gage ada aie Yong intial dari tin HIM Com Ceduttave To dan cbeitas atom mening tater Yambent ton int © Free colesterol diampirg dla ditdvartan le dalam bile. Suga ditube menjadi garam empede , mdalui enim ee a ‘tens: Ade erg ia + sta esbarlag berbate dy ker enin, Semin eight wis, bgja ein dan Wenutun —+ Sehingga Pree Voleylerol akan vSelingga pada orang ta gemuk , warite fertile Cuber / oder extegen Aysi) — Pree Klute chan wensighat Jehingga lolakrel fadarme dalam empedv — Juper= Saternsi - idskung Fale lain: tol fspoliyid yo redo Letty musin yy tiygi — schinggn techentk Felestet Stone pure c=] a . = =) >= = =< " Pathogenesis of Gallstones els = Batu inpobi dari intetine + ode beberapa taman yy Verperyarus techadap pres hoyjgast dan detogjogast biliubin yy ciabutan °/ mutes bier ~ Parait ceperks arcacis 1 mdewn’ Jalan empede — Bi badan Cocing ada Wabi 49 Vira munyehabtan Ascending inpecton fe. Gl. empady ating Fosccle hepatica — wemasubi Sl. amped 7 dapat meryebablen phi bendang tv Aisamping trberdtnya bat, fuga weenyelalebin Frais dan Select sal. empedu behtan amar colangiocar Sironas Terapi Tembedchan —* cholecytectomy (teyargteten Kartory emped Wad recat win Wer Maparoscery ton open) Tika bay dio — LEBPE Clapara scopic Common Bie Duct Erpleration) Ealistone = Common + 207 popu Propenderansi wanita (2/1 ~ Faktor ridto = + Fagemiban © Gitrogen © HiperFoleerlesia Bectambahnyg Wia AR + fair + Babe empety lela amu pd caucasian: Pt + Obesity Femle fertile forty subue ~ etkeogen do tahun. + Pankeeatits © Cholangts 4 Yadang di tal: empedu © Teas ev empedy © Carcivoma of gallblader “Thank You...Aaite Cholecystis oe eee = Radang abut tantowy empede = Biasanya berhuburgan dengan caleuli (babs) © Gabe 1 obvtmtsi pada Farbmg Hartman atau dukes sists Cini Sede edang berpitet, ada npates doe + dlgtriti — baby — belesictitss oy atat Fors J Mating Ranga 2 Ponyeba = - bate ( calculus) dam A- calor Sr9 bige Memy So (Hae ade eto) dicot . Temotaian vapuy info, parake Calmoncia thre ering dren 4 Nerkentawiren? di tl. bier = lebih jateng dengan Wuemput empeds = A> Gains (no stone) colecyss Jorn teed = Ingetsi bobberi ange, Pade so1/ = Sorargan berulang mengatibattan landing empedy Mapebal — Fibrom ( Folesirtits Froms) Mavipestasi Minis = Men Tia tn + Pot Pandial, > Hrutane muhen delerab . Yarnn Kenta Galbladen 49 inthe + UR = Aroued 1 hacks Cn. prentar® pangg ny + Wah bona} + Consant Mantas manl + Daget mrlangsing beherape Jom Wngga burhas basi + Sertg, bensang Roverteman Fie = Vemern Caps = 382) = Asciated janice —+ merandaten feryariatzn Ce — Bate C69 au sindcom i Fonnplites: ar Wau empeds + wunghasilken ittur Wilamari di sat nmpeds dan enyebaltan (Her Distubte berllanjan = Murphy Sign CA) 1 saat fasion “wy wn dave Fo idekidon Jerckeran di luodran] Fawn aot sekior athus - aar gollbler turn. — Mypri perub Warley di fundram faren ot Baa yeti hues + pertonitte Murphy's Sign 1 —ttenelanan ph Rue Ay icprost dale ferrtangen + Myer dy | manehan nape. oli biker gon esate + Ryeri bayarya bethdburgan dy tearnya bats: © Seperk foes ty tapi Wak besbubnegen dy demaen / leubsitesis dan murphy sign (+ © Biaganga Sembnh ‘ebdah beberapa mit ~ Jom © Kay ATR = diag’ yy beclumen + Fantrab: 4 Myer’ Wg intenttasnyo Fuat thet rerun interwiten Cave dimana nyeri erturang Haren AT? berkurang 4 Kontos) igh pita, ugh intensity, teamen Kemper ~ Seundite obtncte. + ble peryeadbnye bate Erapyeme gilader © teh) — Caan dang ‘ompedy alan Magjedi pr = Mucoeele Abu hanye mutin bi cendecurg Vesin star = Ascending hoary: ha di Cop MAKE — inp ve te abs = Rancreadtir + bah pmpede ranyuorbat commen haanek 4 ampule Vakeri — alran Yarra Kergarggy Acending Cholangity — Charo’ bad: 1, Pain 2. Juundite 4. fever © 4, Engels 1 taba ini bert 1. thpotens: doh Sau + Severe crolangits Meri yy ditandai dy pasien munahan NaposCouevoisiers' Law L "dengan edengn therus, ending ompeds yg terion orurgtinn bar dichan cleh ltt raligrat Pale Lauran empedu” = Sering ditemuten pada loses tumor penitema temor “det Wiiary duck ,dertama caput panbrens = Jodi ini tuk mamibedaton dy lelenititis beowis: + eleiablis trons 1 ductor sitter margalon shat aioe banbing emped akon mogert- 4 Dadi Win pasion baring, don dy ferboan Karts emped diterton Feed: — famungtinen porodangan + Tapi tala fentng empedy verae —* wemeriuhi come fess" Law + Courvaisier sign v Seting pada tumor = Namun Fall* tga pada erpyewa t CoD ste Kanbung empedd chan beset: Arute cholecyssittr — Investigation = Blood © FC (woe) gana 6 + LETS CBtirabin, GET, Ale pher , oT/FT) © Aglare + Carlga pantreaths ~ Img OK © Ulbvaaurd cot ~ Special Tent Urasono grag kandang ong Yop remboer © Peattalan dinding lading enped © Babe empad * Debris echo peritoesith Cebar honbrg) Tanda murphy Sonegegi fame ty MurYRy on Wiis ‘op tegen A gor os pnp WS Pericholecystic: Piuid empedu wanelal dso Wager internal, echo debit atv oi awa, ~ Har ode torerter Deuitic thadow hay babe: psteier ava, shadow CT scan Temvan CT dari bolesictbs atu adalah © den handing enpesu + puidulecyrte fat stranding © perdudan dining tandury omped + Edema tubseore Feninsteton roukese + pergumputan cain periulecytic * Aes peidrolegese © Pargumpulan gor dolam benny empade.= se — mangetnad doitey Jotigan murgguraton Uhlan echo + biperecogenisitus/ Vipogenisita CT Sean + dowites Met teuity Aeste Cholecystitis — Sedat. Tet ~ BECP: endoscopic. Retrograde, Cholecystogam Li sudo Jarars dipetat — setornng ai pabwi MRCP t Kerena walaupan ERCP Rindahorym nom mnvong tay! Jaman dulu dkerjakon , meryebeloban angha panbreaths hear Fareng mamasuban ot bentra — rehinggn lol ditiagaltan . anya tempeubic gy sakouary: ~ MRCP: Megnatic Resonance Cholangio Fancredegraphy. = Derik lain dari bolargiogrags = Ube operatit ~ Pacataneus Transhegatte (PTC) ~ Oral. cholangiogram. Management ~~ Batayi asupan om (NFO) © caivon ivavere © Ng ibe astnation (untuk muntala} = Avalguia — morphine ~ Aabbiott W — gram negative cover Li[co- amoxiclav - gontarin — piyecaca\in) = baleiebtowi stele raclsi 9 Lepaceng [open “Thank You...